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Getting relief from PTSD-related nightmares

Nightmares can be one of the most stressful symptoms of PTSD. When you aren’t getting a full night’s rest you’re more likely to feel anxious, irritable and have depressive feelings. It also takes a toll on your physical health, can make you more prone to becoming sick, and even cause more long-term health problems. If you feel you may have PTSD, please talk to a professional to get some help. PTSD does not go away on its own.

If nightmares are keeping you awake, an effective approach to deal with them is called imagery rehearsal. This essentially means keeping track of your nightmares and practicing an alternate ending to them while you’re awake. At some point your mind will become used to this alternate ending, and it can make your dreams less frightening. This is an approach backed by research and has been shown to be helpful to many folks experiencing these kinds of nightmares.

I’m going to show you how to do it. This is an actual therapeutic technique I use with clients of mine who are experiencing PTSD-related nightmares. If you are having difficulty finding an alternate ending try asking people you love and trust for help, or better yet get involved with a counselor like myself to help you with the process.

During the daytime write about your nightmare in as much detail as possible. Rate how much it distresses you from 0 – 10 both before and after writing an alternate ending. There are three options for how to do this exercise. It’s a good idea to make up a little form and print out a few copies so you have them on hand.

Option 1: Write about your nightmare (and the alternate ending!) every time you have one. Do this in the daytime, when you are not trying to sleep or nap. Rate your stress level from 0 – 10 before and after the alternate ending.

Option 2: Write about the nightmare every day, whether or not you have it. Underline places where you feel like you’re blaming yourself, or places you feel stuck. Try to find alternate ways of thinking about the situation. Practice incorporating these thoughts into your alternate ending. Rate your stress level from 0 – 10 before and after the alternate ending.

Option 3: Use an audio recorder of any kind and read your alternate ending out loud. Listen to the recording every day for two weeks. Rate your stress level from 0 – 10 before and after each listening.

Here’s an example:

My dream: I’m at work in the Twin Towers. I’m at my desk. There is a yellow pad of paper on the desk. Suddenly I hear people talking louder and louder. It’s chaotic. All of a sudden I see Jim. I see Mr. York. I hear them screaming. I see people falling down the staircase. I see James crushed under some kind of hot cement. His leg is bleeding. I feel helpless. I wake up sweating.

Starting stress level: 9/10

Alternate ending: I hold on to Jim’s hand and pull him out from the cement. We run down the stairs together. We run and can see the sunlight. We see our families. There is Christie, and Liz. They hug us and kiss us. We feel their hands and faces. We are safe in their arms. We can feel them breathing.

Ending stress level: 6/10

I am indebted to Sheela Raja and her excellent book Overcoming Trauma and PTSD for the specific description of this technique. While most of us are better typists than we are at writing things by hand, to get the most out of this exercise write it by hand. This forms a stronger connection for your mind while you are doing it.

Let’s talk about drugs for a moment. I am not a prescriber so I cannot recommend drugs. I will share what research studies have found. Research has shown a drug called Prazosin is safe and has been effective at reducing trauma nightmares and improving sleep quality. On the other hand, a class of drugs called benzodiazepines (including Xanax, Klonopin, Valium and Ativan) have been used to treat anxiety disorders in general. However for PTSD there is some evidence that shows they may actually worsen recovery from trauma. They can also be addictive.